scholarly journals Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review

10.2196/27075 ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. e27075
Author(s):  
Arash Maleki ◽  
Seyyed Mohammad Qoreishy ◽  
Mohammad Nabi Bahrami
Keyword(s):  
Femoral Head ◽  
English Language ◽  
Surgical Techniques ◽  
Public Health Problem ◽  
Perthes Disease ◽  
Comprehensive Review ◽  
Varus Osteotomy ◽  
Manual Search ◽  
Surgical Methods ◽  
Innominate Osteotomy

Background Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. Objective The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. Methods An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. Results A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. Conclusions This review provides clinicians with a brief guideline for the treatment of patients with LCPD.

scholarly journals Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review (Preprint)

2021 ◽  
Author(s):  
Arash Maleki ◽  
Seyyed Mohammad Qoreishy ◽  
Mohammad Nabi Bahrami
Keyword(s):  
Femoral Head ◽  
English Language ◽  
Surgical Techniques ◽  
Public Health Problem ◽  
Perthes Disease ◽  
Comprehensive Review ◽  
Varus Osteotomy ◽  
Manual Search ◽  
Surgical Methods ◽  
Innominate Osteotomy

BACKGROUND Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. OBJECTIVE The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. METHODS An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. RESULTS A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. CONCLUSIONS This review provides clinicians with a brief guideline for the treatment of patients with LCPD.

scholarly journals Tissue Engineering Strategies for Treating Avascular Necrosis of the Femoral Head

2021 ◽  
Vol 8 (12) ◽  
pp. 200
Author(s):  
Sumit Murab ◽  
Teresa Hawk ◽  
Alexander Snyder ◽  
Sydney Herold ◽  
Meghana Totapally ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Stem Cells ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Hip Replacement ◽  
Surgical Techniques ◽  
Significant Activity ◽  
X Rays ◽  
Early Stages ◽  
Surgical Methods

Avascular necrosis (AVN) of the femoral head commonly leads to symptomatic osteoarthritis of the hip. In older patients, hip replacement is a viable option that restores the hip biomechanics and improves pain but in pediatric, adolescent, and young adult patients hip replacements impose significant activity limitations and the need for multiple revision surgeries with increasing risk of complication. Early detection of AVN requires a high level of suspicion as diagnostic techniques such as X-rays are not sensitive in the early stages of the disease. There are multiple etiologies that can lead to this disease. In the pediatric and adolescent population, trauma is a commonly recognized cause of AVN. The understanding of the pathophysiology of the disease is limited, adding to the challenge of devising a clinically effective treatment strategy. Surgical techniques to prevent progression of the disease and avoid total hip replacement include core decompression, vascular grafts, and use of bone-marrow derived stem cells with or without adjuncts, such as bisphosphonates and bone morphogenetic protein (BMP), all of which are partially effective only in the very early stages of the disease. Further, these strategies often only improve pain and range of motion in the short-term in some patients and do not predictably prevent progression of the disease. Tissue engineering strategies with the combined use of biomaterials, stem cells and growth factors offer a potential strategy to avoid metallic implants and surgery. Structural, bioactive biomaterial platforms could help in stabilizing the femoral head while inducing osteogenic differentiation to regenerate bone and provide angiogenic cues to concomitantly recover vasculature in the femoral head. Moreover, injectable systems that can be delivered using a minimal invasive procedure and provide mechanical support the collapsing femoral head could potentially alleviate the need for surgical interventions in the future. The present review describes the limitations of existing surgical methods and the recent advances in tissue engineering that are leading in the direction of a clinically effective, translational solution for AVN in future.

Phonological Development in Urdu-Speaking Children: A Systematic Review

2021 ◽  
pp. 1-22
Author(s):  
Saira Ambreen ◽  
Carol K. S. To
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Speech Sound ◽  
Future Research ◽  
Phonological Development ◽  
Phonological Acquisition ◽  
Phonological Processes ◽  
Comprehensive Review ◽  
Manual Search ◽  
Meta Analyses

Background Speech and language researchers study phonological acquisition and evaluate the errors that children make to understand this complex process. This information provides clinicians with a scientific reference for better assessment and intervention services to children with articulation/phonological disorders. Urdu is a language spoken by more than 200 million speakers worldwide. However, research on Urdu phonological development is in its infancy. Purpose This systematic review aimed to identify relevant studies and provide a comprehensive review of which aspects of Urdu phonological development have been targeted, along with the reported findings. Method Five phases of the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed. All retrieved studies published between January 1980 and March 2020 and focusing on Urdu speech sound acquisition and/or phonological processes in typically developing native Urdu speakers aged up to 8 years were included in the review. The final search was conducted on May 4, 2020. Results A total of 873 records were identified from five databases and a manual search. Nine studies fulfilling the inclusion criteria were included in the final review. All studies were published in the English language, five of which were unpublished master's theses and four were peer-reviewed journal articles. Four of these studies focused on consonant acquisition, whereas five explored phonological processes. No study focused on the acquisition of Urdu vowels, diphthongs, or consonant clusters. These shortlisted studies were reviewed in detail to determine participants' demographic characteristics, focused areas of phonological acquisition, data elicitation methods and contexts, transcription systems, and major findings. Conclusion This study provides a comprehensive review of the available literature on Urdu phonological development and highlights areas for future research.

scholarly journals Legg-Calvé-Perthes disease: Diagnostics and contemporary treatment

2008 ◽  
Vol 136 (7-8) ◽  
pp. 430-434 ◽  
Author(s):  
Zoran Vukasinovic ◽  
Cedomir Vucetic ◽  
Dusko Spasovski ◽  
Zorica Zivkovic
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Pelvic Osteotomy ◽  
Vascular Supply ◽  
Perthes Disease ◽  
Endocrine Disturbances ◽  
Disease Diagnostics ◽  
Innominate Osteotomy ◽  
Femoral Shortening ◽  
Slight Limitation

Legg-Calv?-Perthes disease represents avascular necrosis of the femoral head in a growing child. It commonly affects children aged 2-14 years, mostly boys, and has familiar pattern. The etiology of this disease is unknown. It is based on avascular necrosis due to variations of the femoral head vascular supply, trauma, coagulation of endocrine disturbances. The disease presents with limping and pain localized in the hip with projection to thigh and knee, frequently accompanied by the limitation of abduction and internal rotation, as well as slight limitation in flexion of about 20 degrees. Plain radiography is most informative additional diagnostic procedure, enabling assessment of the stage of disease, containment of the femoral head within the acetabulum, acetabular coverage and the extent of disease. Main treatment goal is obtaining the spherical congruity of the hip joint. This can be achieved by abduction bracing, varization femoral osteotomies and various innominate osteotomies (sometimes combined with femoral osteotomies). Children younger than four years of age, with minimal femoral head involvement, do not need any treatment. These children with a larger involvement, older than four years of age, with possible containment in hip abducion, should be treated by one of the following procedures: Salter innominate osteotomy, Salter innominate osteotomy with femoral shortening, or triple pelvic osteotomy. The patients with containment of the hip is not possible in abduction (related to subluxation and femoral head crush), should be treated by Chiari pelvic osteotomy.

scholarly journals Outcome of Varus Derotation Osteotomy for Containment of Femoral Head in Advanced Perthes Disease

2021 ◽  
Vol 10 (2) ◽  
pp. 79-85
Author(s):  
Mohammad Masud Rana ◽  
Nokul Kumar Datta ◽  
Mohammad Ishaq Bhuiyan ◽  
Md Asadullah Ripon ◽  
Abu Zihad Mohammad Salim
Keyword(s):  
Femoral Head ◽  
Clinical Information ◽  
Perthes Disease ◽  
X Rays ◽  
Continuous Variables ◽  
Varus Osteotomy ◽  
Neck Shaft Angle ◽  
Visual Analog Scales ◽  
Derotation Osteotomy ◽  
Group B

Background: Legg-Calve-Perthes (LCP) disease, or idiopathic avascular necrosis of the femoral head occurs during early childhood and is caused by impaired circulation in the femoral head. Varus derotation osteotomy (VDO) was described over half a century ago, and is now a popular method for the operative treatment of Perthes disease. Objective: To find out the clinical and radiological outcome of varus derotation osteotomy for containment of femoral head in advanced Perthes disease. Materials and Methods: This observational study was conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from March 2015 to September 2017. Total 20 cases of advanced Perthes disease were enrolled. Pre- and post-operative period were evaluated by interview and clinical examination by using a semi-structured questionnaire. Demographic and clinical information were recorded. All patients had a pre- and post-operative x-rays. We used visual analog scales (VAS) for scoring pain; Wiberg’s central edge angle, epiphyseal extraction index, neck shaft angle and Larson (Iowa) hip score were used to assess the outcome of VDO. Comparison of continuous variables between the two groups was made with Student’s t-tests. Comparison of proportions between Herring groups B and C were made with chi-square tests. p<0.05 was considered as significant. All the data were compiled and sorted properly and the quantitative data were analyzed statistically by using Statistical Package for Social Sciences (SPSS 22.0). Results: In the present study, mean visual analog scale (VAS) score and epiphyseal extraction index (EEI) were significantly (p<0.001) lower in Herring Group B in comparison to that of Group C, but mean WCEA, NSA and HLS were significantly (p<0.001) higher in Herring Group B in comparison to that of Group C. Conclusion: Varus osteotomy gives good results in children aged 6–12 years who do not exhibit any femoral head deformity or flattening, especially those with good containment in abduction in advance Perthes disease. J Enam Med Col 2020; 10(2): 79-85

Rheumatoid Arthritis of the Craniovertebral Junction

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A83-A95 ◽  
Author(s):  
William E. Krauss ◽  
Jonathan M. Bledsoe ◽  
Michelle J. Clarke ◽  
Eric W. Nottmeier ◽  
Mark A. Pichelmann
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Surgical Management ◽  
English Language ◽  
Surgical Navigation ◽  
Surgical Techniques ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Instability ◽  
Surgical Methods

Abstract BACKGROUND Rheumatoid arthritis (RA) is the most common inflammatory disease involving the spine. It has a predilection for involving the craniocervical spine. Despite widespread involvement of the cervical spine with RA, few patients need surgery. The 3 major spinal manifestations of RA in the cervical spine are basilar invagination, atlantoaxial instability, and subaxial subluxations. Surgical management of RA involving the craniovertebral junction remains a challenge despite a decline in severe cases and an improvement in surgical techniques. METHODS We conducted an exhaustive review of English-language publications discussing RA involving the craniovertebral junction. We paid special attention to publications detailing modern surgical management of these conditions. In addition, we outline our own surgical experience with such patients. RESULTS We discuss alternative surgical methods for treating basilar invagination, atlantoaxial instability, and concurrent subaxial subluxations. We detail our surgical technique for transoral odontoidectomy, occipital cervical fusion, and atlantoaxial fusion. We detail the use of spinal surgical navigation in both of these procedures. CONCLUSION Surgical management of RA remains a challenging field. There clearly has been a decrease in cases of mutilating RA involving the craniovertebral junction. Surgical techniques for managing these conditions have steadily improved.

scholarly journals Full arch rehabilitation in patients with atrophic upper jaws with zygomatic implants: a systematic review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Ana Helena Pereira Gracher ◽  
Marcos Boaventura de Moura ◽  
Patrícia da Silva Peres ◽  
Geninho Thomé ◽  
Luís Eduardo Marques Padovan ◽  
...  
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Case Reports ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Manual Search ◽  
Zygomatic Implants ◽  
Electronic Database Search ◽  
Upper Jaw

Abstract Background The main objective of this systematic review was to present the outcomes of the treatment with zygomatic implants (ZIs) in the rehabilitations of atrophic upper jaw. Findings An electronic database search in PubMed, along with a manual search, taking into account language and study period, was performed by two observers; any type of clinical trial and series that included the use of ZIs was used. In the search strategy, the following search terms were used: zygom* AND dental (Implant OR implants) AND edentulous NOT (biomechanic* OR finite element) NOT cadaver. The search was limited to English language, full text, and humans. Literature reviews and clinical case reports were not considered. Forty-two articles published between March 2003 and April 2019 were included in this analysis. The cases of 1247 patients were recovered; these patients received 2919 ZIs. Fifty-two ZIs were removed during the follow-up time. The survival rate of these implants was 98.22%, with a minimum follow-up of 1 month and a maximum of 228 months. Different surgical techniques were used to place ZIs; however, the intrasinusal technique was the most used (23 studies). Post-surgical sinusitis was the most common complication reported in the studies (39 cases). Conclusions Based on this review, ZIs were commonly used for rehabilitation of patients with atrophic upper jaw. The survival rates presented were high, and the surgical technique is dependent on the professional experience and the local anatomy. However, it needed additional clinical evidence on bone resorption, esthetic outcomes, and physiological characteristics.

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